Provider Demographics
NPI:1952416836
Name:MUILENBURG, KIMBERLY ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:MUILENBURG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10817 CHANCELLORSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-3929
Mailing Address - Country:US
Mailing Address - Phone:540-972-2723
Mailing Address - Fax:540-854-0369
Practice Address - Street 1:9445 ZACHARY TAYLOR HWY
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:VA
Practice Address - Zip Code:22567-2126
Practice Address - Country:US
Practice Address - Phone:540-854-0367
Practice Address - Fax:540-854-0369
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203468174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195167OtherBLUE CROSS BLUE SHIELD
VA005589L88Medicare ID - Type UnspecifiedPROVIDER
VA195167OtherBLUE CROSS BLUE SHIELD